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Biomedical subjects

Giovanni de Simone

Publications and source records attributed to Giovanni de Simone.

53 records · Page 3Linked to original sources
PubMed2003

Influence of fat-free mass on detection of appropriateness of left ventricular mass: the HyperGEN Study.

OBJECTIVES: To evaluate the differences between using height(2.7) or fat-free mass for assessment of the appropriateness of left ventricular mass (LVM) in relation to hemodynamic load, and to evaluate the performance of Doppler as compared with M-mode-derived stroke volume for computation of predicted values of LVM. DESIGN: Cross-sectional. SETTING: Population-based. PARTICIPANTS: We studied 2299 participants from the Hypertension Genetic Epidemiology Network Study (prevalent cardiovascular disease in 342). OUTCOME MEASURES: Individual predicted values of LVM were generated by equations using sex, stroke work (systolic blood pressure x stroke volume by either Doppler or M-mode) and either height(2.7) or fat-free mass, as measures of body build, in 228 normotensive, non-obese, non-diabetic participants. Observed LVM was divided by the predicted value and evaluated as 'excess of LVM'. RESULTS: Among 1957 participants without prevalent cardiovascular disease, obese individuals (n = 1008) were slightly younger than non-obese individuals, whereas diabetic participants (n = 294) were slightly older. Excess of LVM was positively related to body mass index (BMI), independently of echocardiographic method and measure of body build, especially when height(2.7) and m-mode stroke work were used, and was greatest in the presence of concentric left ventricular hypertrophy (P < 0.0001). Excess LVM by height(2.7) was progressively greater than that by fat-free mass, as BMI increased (P < 0.0001). In analyses of covariance of association of prevalent cardiovascular disease with age, sex, race, BMI, and excess of LVM (by each method), methods using height(2.7) were more associated with prevalent cardiovascular disease than were methods using fat-free mass (P < 0.02). CONCLUSIONS: Deviation of LVM from values that compensate hemodynamic load can be similarly identified using different measures of body build and methods to generate stroke work. However, the use of height(2.7) to compute LVM as a percentage of that predicted appears to identify deviations from compensatory values that are independently related to prevalent cardiovascular disease more effectively than does the use of fat-free mass.

Adult↗
PubMed2003

Coronary flow reserve in hypertensive patients with appropriate or inappropriate left ventricular mass.

OBJECTIVE: To assess the association between coronary flow reserve (CFR) and levels of left ventricular mass (LVM) exceeding the compensatory needs in arterial hypertension. DESIGN, SETTINGS AND PATIENTS: The association between the excess of LV mass and CFR was assessed in a population of 40 consecutive hypertensive outpatients free of coronary heart disease, 22 with appropriate and 17 with inappropriately high LVM (i.e. LVM exceeding 128% of the value predicted by sex, stroke work and height in m(2.7)). The CFR (the ratio between dipyridamole and basal diastolic peak velocity) of the distal left anterior descending artery was measured by transthoracic Doppler echocardiography. RESULTS: Patients with inappropriate LVM had similar age, body mass index (BMI), baseline blood pressure (BP) and coronary velocities, but lower LV systolic function, post-dipyridamole diastolic peak velocities (P < 0.05) and lower CFR (P < 0.002) than patients with appropriate LVM. CFR was negatively related to the extent of the excess of LVM (beta = -0.44, P < 0.005), independently of potential combined effect of age, BMI and post-dipyridamole diastolic BP. Impairment of CFR (i.e. < 2) was better discriminated by identification of clear-cut inappropriate LVM (P < 0.004) than by the presence of LV hypertrophy (i.e. LV mass index > or = 51 g/m(2.7); P = 0.057). CONCLUSIONS: In hypertensive patients free of coronary artery disease, the degree of reduction in CFR is associated with the excess of LVM beyond the values compensatory for individual haemodynamic load. This relation is also independent of the presence of LV hypertrophy.

Adaptation, Physiological↗
PubMed2003

Left ventricular geometry and hypotension in end-stage renal disease: a mechanical perspective.

Hemodynamic and nonhemodynamic factors are implicated in the maintenance and aggravation of left ventricular (LV) hypertrophy in ESRD. Functional consequences of LV geometry are of substantial importance in patients who undergo dialysis and may contribute to explain the negative outcome related to LV hypertrophy, also in patients without overt coronary heart disease (CHD). Whereas most patients with eccentric LV hypertrophy have systolic dysfunction and the underlying CHD imposes progression of their disease, when overt CHD does not occur to remodel left ventricle, concentric LV geometry is more prevalent in ESRD and functional consequences are different. Concentric LV geometry is very sensitive to abrupt changes of cardiac loading conditions because of increased LV stiffness. Dialysis-related decrease in LV filling pressure reduces Starling forces recruitment and causes a fall in stroke volume as a result of reduced preload. This fall cannot be compensated by increased contractility, as myocardial mechanics is impaired in concentric LV geometry and no functional reserve can be used. When adequate increase in heart rate is not achieved to compensate reduced stroke volume, cardiac output substantially decreases and hypotension occurs. Occurrence of hypotension in the context of concentric LV geometry might contribute to reduce repeatedly coronary blood flow supply in the stiff and thick myocardium and might accelerate myocardial structural deterioration seen in ESRD.

Humans↗
PubMed2003

Coronary vasodilator capacity and hypertension-induced increase in left ventricular mass.

An increase in left ventricular mass represents a compensatory response of hypertensive heart to augmented loading conditions. The concept of inappropriate mass has been proposed to define an increase in left ventricular mass higher than needed to compensate for increased workload. To assess whether inappropriate left ventricular mass is associated with more severe impairment of coronary vasodilator capacity, 64 untreated middle-aged hypertensive patients without significant coronary artery stenosis and 14 normotensive volunteers comparable for age and gender were studied by transthoracic and transesophageal echocardiography to evaluate left ventricular mass, geometry, and coronary flow velocity response to adenosine. Thirty-three patients had appropriate and 31 had inappropriate increase in left ventricular mass, whereas all normotensive control subjects had appropriate left ventricular mass. Compared with control subjects, minimum coronary resistance (0.87+/-0.18 mm Hg per second/centimeter) was increased in both hypertensive subgroups, more in those with inappropriate left ventricular mass (1.34+/-0.23 versus 1.19+/-0.23 mm Hg per second/centimeter, P<0.01), who also exhibited lower afterload-corrected midwall shortening and ratio of peak early and peak late velocities of transmitral flow profile. In hypertensive patients, minimum coronary resistance was related positively to absolute and relative left ventricular wall thickness (r=+0.33 and +0.35, both P<0.01) and negatively to midwall shortening and ratio of peak early and peak late velocities of transmitral flow (r=-0.32 and -0.31, both P<0.02). Thus, in the hypertensive heart, a deviation of left ventricular mass from values compensatory for increased cardiac workload is associated with lower coronary vasodilator capacity, depressed left ventricular wall mechanics, and abnormal left ventricular diastolic filling pattern.

Adenosine↗
PubMed2003

Hypertrophy at ECG and its regression during treatment survey (HEART survey). Rationale, design and baseline characteristics of patients.

BACKGROUND: Left ventricular hypertrophy (LVH) detected at electrocardiography (ECG) is a predictor of an increased cardiovascular risk in essential hypertension. However, uncertainty remains concerning the reproducibility of ECG LVH and the prognostic relevance of its regression over time in hypertension. The aim of this study was to determine the prognostic value of baseline ECG LVH and its serial changes in a large cohort of hypertensive patients. METHODS: The Hypertrophy at ECG and its Regression during Treatment Survey (HEART Survey) is a prospective observational study conducted in 66 Italian centers. Inclusion criteria are essential hypertension with ECG LVH defined by the Perugia score (Cornell voltage criteria and/or a typical left ventricular "strain" pattern and/or a Romhilt-Estes score > or = 5 points) in subjects aged 45-84 years. The treatment of hypertension and other risk factors accords with current guidelines and is individually tailored. ECG is recorded twice at entry and periodically repeated over a 4-year follow-up period. Expert readers (unaware of the clinical findings) classify ECG. The incidence of major cardiovascular events in relation to baseline ECG and its changes over time are assessed, together with the reproducibility in the two baseline recordings. Overall, 708 patients aged 64 +/- 9 years have been enrolled in centers from northern (27%), central (32%) and southern (41%) Italy. Their baseline characteristics are presented. Follow-up is ongoing. CONCLUSIONS: The HEART Survey will examine the prognostic value of baseline ECG LVH and of its regression over time in a wide population of hypertensive patients.

Aged↗
PubMed2002

Prognostic significance of left ventricular diastolic dysfunction in essential hypertension.

OBJECTIVES: We sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension. BACKGROUND: Alterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated. METHODS: In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.4 years), 1,839 Caucasian hypertensive patients (50 +/- 12 years, 53% men, blood pressure (BP) 156/98 mm Hg) without previous cardiovascular events, who underwent Doppler echocardiography and 24-h BP monitoring before therapy. The early/atrial (E/A) mitral flow velocity ratio was calculated and corrected for age and heart rate (HR). RESULTS: During follow-up, there were 164 major cardiovascular events (2.04 per 100 patient-years). The incidence of cardiovascular events was 2.47 and 1.65 per 100 patient-years in patients with an age- and HR-adjusted E/A ratio below (n = 919) and above (n = 920) the median value, respectively (p < 0.005 by the log-rank test). In Cox analysis, controlling for age, gender, diabetes, cholesterol, smoking, LV mass and 24-h systolic BP (all p < 0.05), a low age- and HR-adjusted E/A ratio conferred an increased risk of cardiovascular events (odds ratio 1.57, 95% confidence interval [CI] 1.11 to 2.18, p < 0.01). A 21% excess risk was found for each 0.3 decrease of the adjusted E/A ratio (95% CI from +2% to +43%; p = 0.03). CONCLUSIONS: Impaired LV early diastolic relaxation, detected by pulsed Doppler echocardiography, identifies hypertensive patients at increased cardiovascular risk. Such association is independent of LV mass and ambulatory BP.

Adult↗
PubMed2002

Appetite suppressants and valvular heart disease in a population-based sample: the HyperGEN study.

PURPOSE: Previous studies of the association between the use of appetite suppressants and valvular heart disease have not accounted for the effects of valvular structure and aortic root diameter, which are associated with obesity. We assessed whether the use of the appetite suppressants fenfluramine/dexfenfluramine, either alone or with phentermine, was associated with aortic regurgitation while adjusting for these variables. SUBJECTS AND METHODS: The sample included 2524 adult participants in the population-based Hypertension Genetic Epidemiology Network study. Information regarding current drug use was assessed during a clinical examination. Medication use was continued at the time of echocardiographic study. Expert readers blinded to current therapy read echocardiograms centrally at Cornell Medical Center. Analyses of the associations between use of fenfluramine/dexfenfluramine (alone or with phentermine) and aortic regurgitation adjusted for potential confounders, including aortic root dilatation and valve fibrocalcification. RESULTS: Nineteen participants, all of whom had hypertension, were being treated with fenfluramine or dexfenfluramine (5 on these agents alone, 14 also with phentermine). Aortic regurgitation was present in 32% (n = 6) of those taking fenfluramine or dexfenfluramine versus 6% (162/2505) of remaining subjects (P = 0.001). In multivariate-adjusted analyses, treatment with fenfluramine or dexfenfluramine was associated with aortic regurgitation (odds ratio [OR] = 4.9; 95% confidence interval [CI]: 1.7 to 14) and aortic fibrocalcification (OR = 5.2; 95% CI: 1.9 to 15). CONCLUSION: In a population-based sample, use of fenfluramine or dexfenfluramine, alone or in combination with phentermine, was associated with aortic regurgitation independent of aortic dilatation or fibrocalcification.

Aortic Valve Insufficiency↗
PubMed2002

Relation of insulin to left ventricular geometry and function in African American and white hypertensive adults: the HyperGEN study.

BACKGROUND: It has been suggested that the trophic effects of insulin may contribute to left ventricular (LV) hypertrophy in hypertension, but few population-based data exist to assess the potential impact of insulin level on LV structure or systolic function. METHODS: Fasting plasma insulin levels (log-transformed) in 1,542 nondiabetic African American or white hypertensive participants in the Hypertension Genetic Epidemiology Network (HyperGEN) study were compared to indices of LV geometry and function, with adjustment for potential confounders (age, sex, ethnicity, blood pressure (BP), body mass index, height and antihypertensive drugs). RESULTS: In simple correlation analysis, a weak positive relation (r = 0.078, P =.002) was found between LV mass and insulin, principally due to positive correlations (r = 0.22 and 0.50) of both variables to body mass index. Multivariate analysis, adjusting for age, sex, ethnicity, body size, systolic BP, and antihypertensive drugs revealed a modest negative relation between insulin and LV mass (r = -0.08, P =.001) due to a negative relationship between insulin with LV chamber size (r = - 0.10, P <.001) and no significant relation to LV wall thicknesses. These results were confirmed in additional analysis controlling for a positive relation (r =.19, P <.0001) of insulin to heart rate, and the relation with insulin became slightly more negative when LV mass was indexed for height(2.7) (r = -0.13, P <.001). After adjustment for covariates, there were no significant relations of insulin to LV ejection fraction or stress-corrected midwall shortening; however, insulin was negatively related to stroke volume (r = -0.12, p < 0.001) and was weakly related positively to relative wall thickness (r =.053) (P =.04). CONCLUSIONS: After adjustment for body mass index and other covariates, insulin in nondiabetic hypertensive individuals has weak negative relations to LV chamber size, mass, and stroke volume, and also has weak positive relations to relative wall thickness but not to measures of LV systolic function. Thus, native plasma insulin level may not play a major independent role in the pathogenesis of hypertensive LV hypertrophy or dysfunction.

Adult↗
PubMed2002

Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study.

OBJECTIVE: To determine whether combinations of metabolic risk factors (obesity, diabetes and hypercholesterolemia) influence the magnitude of left ventricular (LV) mass and prevalence of LV hypertrophy. DESIGN: Cross-sectional, relational. METHODS: A total of 1627 hypertensive (85.9% treated, 1036 women, 1041 African Americans) and 342 normotensive (180 women, 183 African Americans) participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study, without prevalent cardiovascular disease, were studied. Echocardiographic LV mass, normalized by height(2.7) or fat-free mass or body surface area (BSA) and the ratio of stroke volume to pulse pressure as a percentage of predicted (as a crude estimate of arterial compliance) were analyzed in relation to obesity [by body mass index (BMI)], central fat distribution (by waist circumference), diabetes (by ADA criteria) and hypercholesterolemia. RESULTS: Obesity, hypercholesterolemia, and diabetes were more frequent among hypertensives than normotensives (all P < 0.001). After controlling for age, sex, race and type and combination of antihypertensive medication, LV mass/height(2.7), but not LV mass/fat-free mass and LV mass/BSA, increased with the number of metabolic risk factors, both in normotensive and hypertensive participants, also after further adjustment for blood pressure (all P < 0.001). Stroke volume/pulse pressure also decreased in hypertensive, but much less in normotensive subjects, with increasing number of metabolic risk factors, independently of relevant confounders (P < 0.0001). Prevalence of LV hypertrophy was predicted by older age, hypertension, central fat distribution, black race and independently increased with the number of associated metabolic risk factors (P < 0.0001). CONCLUSIONS: The progressive addition of metabolic risk factors including central obesity, diabetes and hypercholesterolemia is associated with higher LV mass normalized by height(2.7), independently of hypertension and other important biological covariates. Obesity played a major role in this association. This finding indicates that LV mass is a potentially useful bioassay of strategies of global cardiovascular prevention.

Adipose Tissue↗
PubMed2002

Relations of pulse pressure and other components of blood pressure to preclinical echocardiographic abnormalities.

OBJECTIVE: To evaluate the extent to which pulse pressure (PP) is associated with echocardiographic abnormalities, and in particular to whether PP is related to LV hypertrophy taking into account other blood pressure (BP) components. DESIGN: Cross-sectional. SETTING: University hospital, hypertension outpatient unit. PARTICIPANTS: A total of 275 adults (mean age 47 years, range 19-69, 3% aged > or = 65) with essential hypertension. Overt coronary artery disease, valvular disease and secondary hypertension were exclusion criteria. Subjects were divided in two groups with PP < or = 50 or PP > 50 mmHg. OUTCOME MEASURES: Left ventricular (LV) mass, hypertrophy, LV systolic dysfunction. RESULTS: Prevalence of LV hypertrophy was higher in subjects with clinic PP > 50 mmHg. Subjects with PP > 50 mmHg had higher clinic and ambulatory systolic than subjects with PP < or = 50 mmHg while diastolic BP did not differ between groups. PP and systolic BP, either clinic or ambulatory, showed similar correlation to LV hypertrophy in separate logistic multivariate models. Using different methodologies, PP was not related to LV mass index or hypertrophy when the effect of its component systolic BP was taken into account. In separate analyses, PP was not significantly related to ejection fraction or midwall mechanics. CONCLUSION: Middle-aged clinically healthy hypertensives with PP > 50 mmHg had two-fold higher prevalence of LV hypertrophy than those with PP < or = 50 mmHg, which may contribute to the higher cardiovascular risk in subjects with higher PP. However, in our sample, PP was not related to LV hypertrophy independently of systolic BP, suggesting that systolic BP is the explanatory link of the relation between PP and LV hypertrophy.

Adult↗
PubMed2002

Left ventricular hypertrophy in hypertension as a predictor of coronary events: relation to geometry.

The present review examines epidemiological evidence for a relation of left ventricular hypertrophy with coronary heart disease, and mechanisms that may represent pathophysiological links between left ventricular hypertrophy and coronary events. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of coronary heart disease, and when geometry is concentric the relation is even stronger. In addition to its association with risk factors for atherosclerosis and mechanisms that precipitate acute heart attacks, left ventricular hypertrophy also directly predisposes to and aggravates clinical presentation of coronary heart disease through a number of biological mechanisms. These include the following: increase in oxygen requirement related to left ventricular geometry; coronary hypertension, with endothelial dysfunction and reduced coronary reserve; diastolic dysfunction; and structural remodelling of myocardium and vascular bed. Some of these alterations are also worsened by underlying coronary heart disease, and can potentially be maintained by loop mechanisms. A recognizable stage of abnormal coronary haemodynamics in the context of left ventricular hypertrophy is probably that at which coronary reserve is impaired in the absence of any other sign of heart disease; in many circumstances, this may occur early in the disease process.

Coronary Disease↗
PubMed2002

Prognosis of inappropriate left ventricular mass in hypertension: the MAVI Study.

To evaluate the prognostic impact of left ventricular (LV) mass exceeding individual needs to compensate hemodynamic load, the percentage of excess of echocardiographic LV mass in relation to individual ideal value predicted by gender, stroke work, and height (in meter(2.7)) from a reference population was assessed in 1019 white hypertensives (627 women [24% obese] and 392 men [17% obese, P<0.02 versus women]) without prevalent cardiovascular disease or type 1 diabetes, from the Italian multicenter, prospective study MAVI. Low LV mass (<73% of predicted) was found in 36 patients (3.5%), 661 had appropriate LV mass, and 322 (37%) had inappropriate LV mass. During follow-up (35+/-11 months), 52 fatal or nonfatal primary cardiovascular events occurred. Age, systolic blood pressure, and LV mass as a percentage of the predicted value were significant predictors of cardiovascular events (all P<0.01), independently of gender, glycemia, antihypertensive treatments, and body mass index, even in subgroups with or without LV hypertrophy. Survival analysis showed that cardiovascular risk increased stepwise from the lowest to the highest quintile of LV mass as a percentage of predicted value (P<0.01). The excess LV mass showed incremental prognostic value compared with assessment of traditional LV mass (P<0.01). Thus, inappropriate LV mass predicts a risk of cardiovascular events, independently of risk factors, and remains a significant predictor of risk either in the presence or in the absence of traditionally defined LV hypertrophy.

Cardiovascular Diseases↗
PubMed2002

[Echocardiographic evaluation of ventricular hypertrophy].

Quantitative echocardiography is the gold standard for the evaluation of abnormalities in left ventricular (LV) geometry and systolic function, information very important for risk stratification, and also applicable in clinical practice when some conditions are met. Few primary measures (LV diameter, septal and posterior wall thickness) provide a valuable information which fully represents the type and degree of hemodynamic alteration. These measures should be collected ideally by M-mode tracings, but often M-mode examination cannot be performed. When M-mode is suboptimal, LV mass can be computed using two-dimensional imaging and the formulas used for M-mode. LV mass is expressed as an index normalized for some measure of body size. Normalization for height in meters to the power 2.7 can identify a higher proportion of individuals at high cardiovascular risk and provides a greater attributable risk than other methods of indexation. When LV hypertrophy develops to provide sufficient strength to compensate for hemodynamic overload, the increase in LV mass is not clearly associated with increased cardiovascular risk. In contrast, individuals with LV mass inappropriately high as compared to the value sufficient to compensate for hemodynamic load at a given body size present with a phenotype characterized by high cardiovascular risk, even in the absence of arterial hypertension.

Echocardiography↗
PubMed2002

Quantitation of left ventricular mass and function: balancing evidence with dreams.

The quantitative evaluation of the echocardiographic geometry and function for non-ischemic, symmetrically contracting left ventricles is increasingly requested, even when the request is not clinically fully justified and does not take into account the feasibility and reliability of measurements. The general opinion is that, despite a number of technical limitations, the overall information gained from left ventricular (LV) quantitation has a crucial importance for risk stratification, mainly due to the prognostic impact of echocardiographically evaluated LV hypertrophy. This trend tends to automatically transfer epidemiological evidence into clinical application, without consideration of the consequences of the transition of standard errors into single cases. Two recent studies, through differently designed, have demonstrated that the test-retest intraobserver variability of LV mass performs well enough to allow, in most circumstances, the identification of patients with LV hypertrophy. In contrast, the variability of nominal, individual values is high. Tables are available to weight the probability of true biological change when comparing values in the same patient. To a lesser extent, the same conclusions as for LV mass can be applied to measures of systolic function. The technical reliability for measures of diastolic filling is generally good or very good, but the intrapatient variability is probably higher than with measures of LV geometry and systolic function. Moreover, the utility in clinical practice of measures of diastolic filling should be proven. In general, the accurate quantitation of LV geometry and function implies reliable methods and appropriate learning procedures in every echo lab, according to the procedures and the achievements recommended in the current literature. The development of new echocardiographic techniques and the adoption of the procedure of off-line revision of echocardiographic studies might further reduce the variability in the quantitation of measures of LV geometry and function.

Echocardiography↗
PubMed1992

Relation of Age to Left Ventricular Structure, Function, and Systemic Hemodynamics in Normotensive and Hypertensive Employed Adults.

To determine the effect of age on left ventricular status and systemic hemodynamics, we evaluated by echocardiogram older (age at or above 60 years, n equals 148) and younger (age is less than 60 years, n equals 472) employed adults. Using World Health Organization criteria, the population was divided into the following blood pressure strata: normotensive (n equals 142), borderline hypertensive (n equals 194), and sustained hypertensive (n equals 284). Older subjects were compared to younger subjects in each blood pressure stratum. Older subjects with borderline hypertension and sustained hypertension had a higher systolic blood pressure and wider pulse pressure than younger individuals. Older subjects with borderline hypertension had higher left ventricular mass index (106.7Â+/-28.7 vs 93.9Â+/-22.4, P equals 0.03), and greater wall thicknesses and relative wall thicknesses than younger subjects. Older borderline hypertensive patients had greater left ventricular wall thicknesses and mass, but closely resembled both age groups of sustained hypertensive patients in this regard. Older and younger individuals with borderline hypertension had similar mean cardiac outputs, stroke volumes, and peripheral resistances. In contrast, older patients with sustained hypertension had a lower stroke volume, stroke volume index, cardiac output, cardiac index, and fractional shortening, and a higher total peripheral resistance than their younger counterparts. There were no significant relations between age and any echocardiographic measurement in normotensive subjects. Borderline hypertensive individuals exhibited weak relationships between age and left ventricular wall thicknesses (r equals 0.17; 23) and left ventricular internal dimensions (r equals -0.19 and -0.21). Very weak negative relationships were identified between age and cardiac output for both hypertensive groups. In conclusion, increasing age had relatively little effect on cardiac status in either normotensive or sustained hypertensive employed adults, but was associated with greater left ventricular hypertrophy among individuals with borderline hypertension according to the World Health Organization classification. These results are consistent with the independent value of age and left ventricular mass as predictors of hypertensive complications, but also suggest that under some circumstances, greater age or longer exposure to hypertension may magnify the target-organ effects at a given degree of blood pressure elevation.

Journal Article↗